Prevalance and determinanats of folic acid utilization among women of childbearing age at Mbale regional referral hospital eastern Uganda.
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Date
2026
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Busitema University
Abstract
Background:
Folic acid supplementation before conception and during early pregnancy is a proven and cost-effective intervention for preventing neural tube defects and improving maternal and neonatal outcomes. Despite national and global recommendations, folic acid utilization among women of childbearing age remains suboptimal in many low-resource settings, including Eastern Uganda. Limited context-specific evidence exists regarding the prevalence and determinants influencing folic acid use among women attending maternal health services at Mbale Regional Referral Hospital.
Objective:
This study aimed to assess the prevalence and determinants of folic acid utilization among women of childbearing age attending Mbale Regional Referral Hospital in Eastern Uganda.
Methods:
A cross-sectional study design was conducted at selected mother-care points of Mbale Regional Referral Hospital (Antenatal care (ANC) clinic and Postnatal care Ward (PNC). This was quantitative study involving women aged 18–49 years attending antenatal and postnatal services, selected using a probability sampling approach. Data was collected using structured interviewer-administered questionnaires adapted from validated tools. Quantitative data was analyzed using descriptive statistics and inferential analysis to identify factors associated with folic acid utilization.
Results
334 women of childbearing age were recruited in this study and out of these, 70.1% (234/334) reported using folic acid at least once within the previous 12 months. However, only 8.1% of this population of mothers initiated folic acid supplementation before pregnancy or preconception, meanwhile 46.7% commenced supplementation during the first trimester of pregnancy.
At bivariate analysis,socio-demographic factors associated with folic acid utilization included age(p=0.049),religion(p<0.001),and occupation(p=0.004).The factors associated with folic acid utilization, included the maternal-related factors like parity(p=<0.001),planned pregnancy(p=0.036),gestational age at first ANC visit(p<0.001),Knowledge of folic acid(p<0.001),decision making regarding folic acid use (p<0.001),perceived need for folic acid supplementation(p<0.001),Knowledge of appropriate timing of folic acid use (p<0.001),and perceived risks of birth defects without folic acid(p<0.001). The health system-related factors included, counselling on folic acid received(p=0.042),availability of folic acid at health facility(p<0.001),partner support(p<0.001),family encouragement(p<0.001),Received information on folic acid(p<0.001),folic acid recommendation by health worker(p<0.001),availability of health workers(p<0.001),ease of obtaining folic acid(p<0.001),cost of access(p<0.001) and the usual source of folic acid(p<0.001).
In bivariate logistic regression analysis, women with knowledge about folic acid were nearly thirteen times more likely to utilize folic acid compared to those with less knowledge (COR=12.86; 95% CI: 6.59–25.09; p<0.001).Consequently women who initiated Antenatal visits after 12 weeks were 80% less likely to utilize folic acid than those attending Antenatal before 12weeks (COR=0.20; 95% CI: 0.12–0.33; p<0.001).Participants who had been advised by health workers to take folic acid were eighteen times more likely to utilize folic acid than those who had not received such advice (COR=18.06; 95% CI: 8.02–40.66; p<0.001).Mothers who received information on folic acid had seven-folds higher odds of utilization (COR=7.05; 95% CI: 3.76–13.22; p<0.001).
After adjusting for the potential confounders in multivariable logistic regression, three factors remained independently and strongly associated with folic acid utilization. Women who initiated Antenatal care after 12 weeks gestation had significant lower odds of folic acid utilization compared with those booking before 12 weeks (AOR=0.33; 95% CI: 0.18–0.61; p<0.001), indicating a 67% reduction in the odds. Furthermore, women who had been advised by health worker to take folic acid were approximately five times more likely to utilize folic acid than those not advised (AOR=4.67; 95% CI: 1.68–13.01; p=0.003) and women who reported regular intake of folic acid when prescribed were more likely to utilize (AOR=2.48; 95% CI: 1.83–3.35; p<0.001)
Conclusion:
Folic acid utilization among women of childbearing age attending Mbale Regional Referral Hospital was relatively high during pregnancy, but remained low during the critical preconception period. Early Antenatal attendance, health worker recommendation and adherence to prescribed supplements were independent predictors of folic acid utilization. Therefore, strengthening preconception health education programs, promoting early Antenatal attendance and enhancing health worker counselling and prescription quality practices may significantly improve folic acid utilization and hence contributing to prevention of neural tube defects, with other adverse pregnancy outcomes.
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Undergraduate research report
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Citation
Okello, D. (2026). Prevalance and determinanats of folic acid utilization among women of childbearing age at Mbale regional referral hospital eastern Uganda. [Unpublished undergraduate research report]. Busitema University.